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the rate of production is equal to the rate of outflow which helps to maintain IOP within a normal range.
eye disease that is caused by the increased IOP which causes damage to the optic nerve & results in gradual loss of vision with rush for complete blindness.
average level 15-16 mmHg
IOP >21 = abnormal & increased risk for glaucoma
IOP >31 = requires treatment because they are associated with changes in vision
Drug Therapy for Glaucoma
some drugs used take 6-8 weeks to reach their peak values & some have effects 2-4 weeks after drugs have been discontinued.
Two Mechanisms of Action
1. Increasing the outflow of aqueous humor
2. Decreased the formation of aqueous humor
drug of choice, longer duration of action, fewer side effects, used alone and with beta blockers
Prostaglandin Side Effects
1. Heightened pigmentation which turns the blue iris to a brown color
2. May be irreversible
3. Thicker and longer lashes
4. During the first month of therapy...
a. local irritation of the eye
b. stinging of the eye
*Because of the effects, normally administered just before bedtime.
Beta Blockers, Alpha Agonists, Cholinergic Agonists, Non-selective Sympathomimetics, Carbonic Anhydrase Inhibitors, Osmotic Diuretics
Beta Blocker Facts
"olol" drugs, can lower the IOP by 20-30%, produce fewer ocular effects than autonomic drugs: local burning & stinging, blurred vision
Beta Blocker Side Effects
Usually there is not a significant amount of systemic absorption, but if there is:
*Use caution in patients with asthma and heart failure
Alpha Agonist Facts/Action
"nidines", decrease production of aqueous humor, not frequently prescribed, applied topically (eye drops/opthalmic solution)
Alpha Agonist Drugs
Apraclonidine (Iopidine) - reduced IOP during or following eye surgery
Brimonidine (Alphagan) - adjunct therapy in combination with glaucoma drugs
Alpha Agonist Side Effects
headache, drowsiness, dry mucous membranes, blurred vision, irritated eyelids
Cholinergic Agonist Facts/Action
produce miosis (constriction of the pupil), contracts the ciliary muscle, this allowed greater outflow of aqueous humor and lowering IOP, applied topically (eye drops/opthalmic solution)
Cholinergic Agonist Side Effects
headache, induced myopia (constriction of pupil), decreased vision in low light
Cholinergic Agonist Toxicity
Occurs with systemic absorption:
salivation (increased), tachycardia, hypertension, bronchospasm, sweating, nausea, vomiting
*Because of the greater toxicity, cholinergic agonists are normally used only in patients with open-angle glaucoma who do not respond to other drugs
Non-selective Sympathomimetics Facts/Action
produces mydriasis (pupil dilation) - increases the outflow of aqueous humor resulting in decreased IOP, not as effective as beta blockers or prostaglandins
Non-selective Sympathomimetic Side Effects
1. local burning and stinging
2. blurred vision
4. photosensitivity (because of dilation)
Non-selective Sympathomimetic Adverse Effects
converted to epinephrine and effects are identified to epinephrine, if reaches the systemic system it will increase the blood pressure and heart rate, because of the systemic effects they are rarely used
Carbonic Anhydrase Inhibitor Facts/Action
"zolamide", given topically or orally (systemically), decreases the production of aqueous humor
Carbonic Anhydrase Inhibitor Drugs
Dorzolamide (Trusopt) - topical
Acetozolamide (Diamox) - oral (systemic)
Carbonic Anhydrase Inhibitor Side Effects
-fewer except for photosensitivity
-effective at lowering IOP but produces more systemic effects than other classes.
*lethargy, nausea/vomiting, depression, paresthesias, drowsiness
-contain sulfur and may cause an allergic reaction
-oral forms are diuretics so electrolytes and I&O must be monitored because they can reduce IOP quickly
Osmotic Diuresis Facts/Action
given orally or IV, quickly reduces plasma volume, effective in reducing the formation of aqueous humor, used prep and postop with ocular surgery, emergency treatment for acute closed-angle glaucoma
Osmotic Diuresis Side Effects
headaches, tremors, dizziness, dry mouth, fluid and electrolyte imbalances
*can cause thrombophlebitis and venous clot formation near the IV site
(at risk for dehydration & electrolyte imbalances)
Mydriatic Drugs Facts/Action
dilate the pupil to allow better assessment of the retinal structures, the response can last 3 hours up to several days
Mydriatic Drug Side Effects
cause intense photophobia and pain in response to light; can worsen glaucoma by impairing aqueous humor outflow and increasing IOP
Cycloplegic Drugs Anti-cholinergic Facts/Action
dilate the pupil, paralyze the ciliary muscle, prevent the lens from moving during assessment
Cycloplegic Drug Side Effects
cause severe blurred vision and loss of near vision;
the response can last 3 hours up to several days
Atropine (Isopto Atropine)
Cyclopentolate (Cyclogyl, Pentolair)
-available in eye drops
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